Provider Demographics
NPI:1114476413
Name:WITH OPEN ARMS / REPRODUCTIVE HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:WITH OPEN ARMS / REPRODUCTIVE HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIK-NICELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-442-0400
Mailing Address - Street 1:2505 LUCAS ST
Mailing Address - Street 2:STE B
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3340
Mailing Address - Country:US
Mailing Address - Phone:707-442-0400
Mailing Address - Fax:707-442-0404
Practice Address - Street 1:2505 LUCAS ST
Practice Address - Street 2:STE B
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3340
Practice Address - Country:US
Practice Address - Phone:707-442-0400
Practice Address - Fax:707-442-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44510207Q00000X
CANMW 235678367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty